Smoking cessation is everybody’s business

Disclaimer: The following transcript has been autogenerated and may contain occasional errors or inaccuracies resulting from the automated transcription process.

Assoc Prof Caroline Johnson (00:00:05):

Welcome to everyone who’s joined for tonight’s live webinar and also to any viewers who might be watching us later via the recording. It’s lovely to have you all here this evening, and I’d like to begin by acknowledging the traditional custodians of the Land, sea, and waterways across Australia upon which I and the panel and the audience are located. So I’m coming to you from Wurundjeri Land and I’d like to pay respects to the elders past and present, and I’d also like to acknowledge the memories and traditions and culture and hopes of Aboriginal and Torres Strait Islander people. So I’m your MC for tonight. My name’s Caroline Johnson. I’m a GP from Metropolitan Melbourne and I’ll quickly introduce the other people who are with us tonight because we’ve got a lovely panel here and they’re all visible on your screen. So I’ll just start first with Kate.

(00:00:54):

I won’t go into bios too much because you can actually see them on the website and read all the background, but Kate’s here because she’s a Mental Health Nurse with a lot of experience in the topic we’re going to talk about tonight. But more importantly, Kate and I have worked together during the mental health nursing practise initiative. She was a Mental Health Nurse in the practise that I work in Melbourne, so we’ve got a longstanding relationship of collaborating in the mental health space. Next we have Mat and Mat is bringing the perspective of the psychiatrist and has a lot of expertise in this area as well that will help us below Kate. We have Sally and Sally’s a psychologist who’s also done a lot of research in this area which will provide help for us. And last but definitely not least, we’ve got Shannon who’s the lived experience voice here and I’m particularly grateful Shannon for you to coming tonight.

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It’s a very important topic to have the experience of someone who’s also received and not just delivered healthcare. So thank you for being here tonight and for sharing, and I know I’m aware you also do research in this space, so your expertise, lived experience and in research is very welcome. So I think I’ve covered all the panel I can see on my screen and the next slide is really just covering off the learning outcomes. So any good educational activity, I hope you were aware of what we were going to talk about tonight because that’s what you’re going to hopefully learn. We’re going to give you a little bit of data around the prevalence and risks of respiratory disease that is experienced by people with mental health concerns, but mostly this will be talking about how to start conversations about smoking cessation and really to help people to do that in a way and shown by evidence to actually work.

(00:02:44):

So obviously we’re going to talk a little bit about hurdles but hopefully focus a lot on enablers tonight as well. So do this for you. We’ve really broken the session up into four parts and most of it will be the panel all talking to each other, so we’ll see how we go getting through a little bit of content. So the first bit we will talk about what we call the lay of the land, so understanding the interrelationship and prevalence and risks associated with smoking. Just so everyone in the audience is familiar. I know from the stats of all the people here tonight, there’s a really good mix of professionals and so welcome. I can see there’s also going to be a few GPs in the audience as well. So hello to my tribe. I’m sure you’ve got a lot of training in knowing this, but the stats will help.

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Then we’re going to move into the opportunities and guidelines and resources and you’ve all received the pre-reading. So as a predisposing activity, we shared you some guidelines that are very dear to my heart, the R-A-C-G-P smoking cessation guidelines, which I hope you’ve taken the opportunity to look at. Then we’ll move into more of a discussion about the hurdles and enablers and I hope that will then lead because we’re role modelling multidisciplinary care by being five on a panel all from different disciplines. I’m hoping we’ll role model some ways that we can all work together because that’s a very important part of getting success in this area. The last thing I need to cover before I hand over to Shannon to speak about the lay of the land is to remind you that you, if you want to claim CPD points or fill out the feedback survey, there’s a place called supporting.

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There’s a resources tab that you need to click on to access things and also you can click on that to see the learning outcomes if you have any tech support needs. There’s a tech support tab which is in the top right hand corner of your screen. So I hope you can find that if you’re having any issues there. And if you want to submit a question to the panel, please click the three dots on the bottom right hand corner and there’s a thing that says ask a question. If you click on that, you can ask a question and we’ve got a team from MHPN who helping us to send the questions through and I’ll try and help shuffle through and cover as many of your questions as we can manage. So on that note, I’d like to hand over to Shannon who’s going to do a little bit about the lay of the land just to set the scene for us. Thanks Shannon.

Shannon Harwood (00:05:06):

Thanks Caroline. Good evening to everybody. So if you happen to have called past my bio on the way in tonight, you’ll see that I’m an ambassador for Equally Well, which is why I’ve been asked to give a little background to the lay of the land. The Equally Well team do set me up beautifully. I can see on the top of this slide this says by Shannon Harwood, but full disclaimer, I did not write the unequally unwell report. I had love to be able to put that on my bio, but I can’t. That’s from the Equally Well team in some ways. What brings us all here tonight is the concept of being unequally unwell and I’m surprised when I work in this space how many people it is, whether that’s clients, consumers or various allied health professionals who aren’t actually aware of exactly what that means in terms of a mortality gap for people experiencing mental illness.

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So we’re looking at between 14 and 23 years reduced life expectancy for this group tonight we gather for smoking cessation, so that’s how we are looking at it, but I just want to mention that the summary report obviously has a lot more in it covering than just smoking cessation. So I’ll quickly whip through this slide. I just want to leave a little summary report up there for a moment so that you have an eyeball on what that looks like. So of a population of 24 million in Australia, we’re looking at where would this unequally unwell report, where did we draw our information? Well, it was drawn from the census, the death register, the Medicare benefits scheme, the pharmaceutical benefits scheme within that identified with 5 million people who access the medical benefits scheme or the pharmaceutical benefits scheme in Australia in a year, 160,000 deaths. When we look at this data, one of the things that we need to remember is not everybody who turns up to a medical appointment, even with a mental health condition, will have that appointment registered as a mental health appointment.

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So the figures that we are presenting tonight in some ways are conservative figures on what might be presented. In the same way, not everybody who has a mental health condition may well be using medication for it, so you won’t show up on a pharmaceutical benefit scheme. Doesn’t mean you’re not included in this group and if you can just go to the next slide, I think the graph here on the left says an awful lot in a very quick way. So of a hundred thousand deaths there we have a rate of 9.3 compared to 3.9, that’s almost two and a half times the rate of death for people with mental health conditions on the right. When we look at that, for every a thousand males who access mental health services, 14 died for every thousand females who accessed mental health services, seven died 14 seven. For every thousand people in the total population, we have a figure of four.

(00:08:32):

So for the odd 22% of Australians who access medical mental health services that accounts for 49% of the death rate. I mean that’s just staggering. If you remember no other figure than that. 23% of the population, 49% death. What brings me here tonight, next slide. Thank you. What brings me here tonight as an Equally Well ambassador is that I got interested in physical health outcomes for people with mental illness. I had a diagnosis of serious mental illness. I used metabolic interventions to treat that mental illness which brought me together with mental illness and physical health. And it’s sort of interesting because I’m lived experience, so I’m not a nurse or a GP or a psychiatrist, so I’m not a kidney specialist, I’m not a respiratory disease specialist within my person. I bring here tonight mental health, physical health, my kidneys, my lungs, all the pieces of me.

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I can’t segment out my health into mental health or physical health or segments. This is what I love about the Equally Well organisations. What I love about what brings us here tonight. So we have people from all different areas who have come together in the recognition that health means both physical health and mental health where you go after tonight if you head into the equal resources to have a look at the summary report or the full report, I just want to cover off some terms that you’ll find so that you’ll know what you’re looking at there. So when we’re talking about premature death for this group, if the people under the age of 15 haven’t been counted in this, not usually affected by chronic health conditions under the age of 15, life expectancy about 74 deaths before that age are considered premature deaths and when statistics are mentioned in the report where they relate to specific areas or specific target ranges, we are comparing apples with apples.

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So it has been sort of standardised against groups. So we are doing direct comparisons there and the excess deaths is, I think I’ve covered that off, is a number of deaths in a group above what would be expected. So when we look what would be expected from the general population and then we look at that for the people who carry mental health diagnoses, those reports are available on the Equally Well website, both the full report and then for those of us, what’s that little thing that people say too long did not read. For those of us who are in the too long did not read category, you can go to the summary report for people who are in the too long did not read category for the summary report. You can go to the quick fact sheets and I mentioned that because maybe a quick fact sheet is what’s the most useful thing just to pop around your workplace.

(00:11:48):

Maybe that’s the most useful way to bring attention to this gap in mortality for this group. Next slide. Breath yourself. Top line lung cancer. It is no surprise that the lung cancer rates are higher in a population group where the rates of smoking are higher. That seems natural, but if you are looking at that top bar graph there, like me and let’s just look at that for a moment. Let’s just think about the death rate associated with lung cancer. Let’s just look at that with the orange bar being people who are in the people who experience mental ill health, mental illness, the beige bar being the normal population of the general population, I would just draw everybody’s attention to that again and again and again because I can’t think of any single graphic that could show the difference in scale in which this population is affected and how that affects their mortality rate.

(00:12:51):

Or we could jump down to the second bar on that graph for heart disease. Again, we’re here for smoking tonight, so smoking plays a part in that as well. And then we go through to respiratory diseases. Again, we’re looking at smoking, we get to the bottom of this chart and we have breast cancer and colon cancer and we can get into causation there as well, but we can just have a look at the general health of this population. I’m in this population, so how those graphs affect me when I look at them and how they affect you and they look at them, they might be two separate things and it’s worthwhile I think bringing that human element in and into this conversation because when we work in our practises with people, and I’ve had a person to person practise too, it’s humans that we’re dealing with, not this bar chart. Next slide.

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So the run-on effects, I mean we’ve got the basic lung cancer that we had on the previous slide. Things I get Equally Well together is, and that I mentioned when I began this was I am not just my lungs, I am not just my kidneys, I am all of me. And so my habits and my health behaviours don’t just run over in a smoking clinic or how much the clinic, they can run over into things like respiratory conditions too in for example, how long someone from the mental health population may utilise increased hospital rates for bed stays for extended hospital stays and how general health outcomes are feeding into those figures. So if you’re working in a bureaucracy position, looking at number of bed stays and costings, these are human outcomes and these are system outcomes as well.

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I will leave you with the graph on the right there. Sorry about that noise and we’ll go next slide. That’s just a quick touch into what’s available in terms of the statistics in the equally unwell site here tonight. Apart from being an Equally Well ambassador, I just want to open up my lived experience for people to ask me any questions and I want to preface that really quickly before we head to the general conversation by saying I was a packa day smoke of 30 years. I was waking in the night to smoke. I think someone will tell me that was a fairly heavy dependency or nicotine with a serious mental illness and I’m now neither of those things. How did that happen? Thank you Caroline. That’s the introduction to what’s being offered there Equally Well with the reports.

Assoc Prof Caroline Johnson (00:15:50):

Thank you very much Shannon and thank you for sharing your lived experience and giving the participants tonight the opportunity to ask you any question that they want. So there’s a good invitation asking someone who’s managed to achieve what Shannon’s just described of becoming well and becoming a non-smoker is an incredible opportunity to find out more. I always say to the young gps I teach, don’t just read the guidelines, actually ask people who have had success themselves because their experience of what works for them is very powerful to share with other people and I’m sure there’ll be many mental health professionals on the webinar tonight who are familiar with that as well. Sharing the experience of others is incredibly powerful way of giving people the hope that they can change. So thank you for that and thank you. There’s a few chats questions coming through already. Some of them are a bit about medication, which I’ll leave just till the next segment where we are going to talk about the guidelines and I think that’s when some of the questions around treatments and medication and stuff might be more relevant. First of all, I want to give the other panel members a chance to comment on the statistics we’ve just seen. I’m imagining for none of you in this space on this panel as experts we’ll find this surprising, but is there any reflections or comments that anyone wants to make?

Kate Cogan (00:17:09):

Yeah, look, it’s funny, I know all this, but Shannon showing that graph is just like a slap in the face. It’s so powerful and thank you, thank you for highlighting that It really brings it home that we have to work harder at this

Assoc Prof Caroline Johnson (00:17:32):

And I think Kate, that’s helpful also because I know I was one of the people involved in this report and the lived experience voice on the report was very courageous to remind those of us who were looking at the stats and talking about the data and saying was it reliable and how could we interpret reminded us these are not just numbers, they’re people and I think that’s one of the traps we sometimes fall into clinicians of talking about labels and diagnosis and forgetting that we’re actually talking about people. So that’s a very important reminder. Sally, you also wanted to add something.

Sally Plever (00:18:05):

I do and thanks Shannon. I think it really gives people a powerful view of the actual impact that this has because you can kind of talk about smoking, but actually knowing how it affects someone on the other side is so important. The rates are just ridiculous in mental illness. It’s just an unbelievable scourge that we have not been able to tap into. It’s a problem that has been going on for such a long time and while the general population has been dropping down in smoking, so for example where Queensland we’re about 10% or under as there are a lot of other states, when we look at our population of people with serious mental illness, for example in our Queensland services, we’re looking at 55% or more of people in our inpatient and outpatient services and up to 75% if you’re indigenous as well. And these are rates that are just not shifting and a lot of that is because of the inequity of people never being actually offered the opportunity to access a lot of the ways in which you can quit smoking or being asked about it at all. So this topic is very close to my heart. I worked around it all the time and it’s just really good to see that we’re actually getting a webinar dedicated to it.

Assoc Prof Caroline Johnson (00:19:24):

Thank you Sally. And I think this segues beautifully into what we need to do tonight, which is a bit of myth busting. It’s very easy to say that people with mental health issues, the last smokers in Australia, what’s going on and the myths might be, well they don’t want to stop because it helps them with their mental health. I’d like to move now to unpacking some of those myths and I’m thinking Mat might like to lead the charge because when we asked to provide some myths, he provided perhaps the longest contribution to the list of the myths that need to be busted. Mat, any myth you’d particularly like to start with?

Assoc Prof Mat Coleman (00:20:02):

I think it’s the myth that Shannon alluded to in our previous conversation as we were preparing for this, which is that people with mental health diagnosis and problems and are happy users of cigarettes and tobacco and that they don’t want to give up and that smoking is good for their mental health and I think they’re probably the biggest myths that exist in the mental health and indeed the alcohol and other drug sector as well. I still find it quite paradoxical that you can turn up to an alcohol and other drug service and get services for cannabis, heroin prescribed medications, but if you are nicotine dependent and tobacco dependent, actually you have to go somewhere else to get help, go back to your gp. So even in services that are dedicated towards people who have a substance related addiction and problem, we seem to treat smoking and tobacco use very differently.

(00:21:09):

The other just additional point to some of the comments that Shannon was making and in relation to the data is that I’m aware as a psychiatrist has spent a long time training as a medical practitioner a long time then training as a specialist psychiatrist and then to be told and understand when you look at what we do that actually the single most important intervention with the biggest impacts that I could undertake after 12 years of training in terms of reducing morbidity and mortality was to address smoking cessation, which a lot of people don’t want to hear, but I think as mental health professionals trying to improve your craft to actually hear smoking cessation is going to have the biggest impact in your career if you were to choose one intervention I think kind of busts a lot of those myths. So I’ll stop there and let others ask questions or talk.

Assoc Prof Caroline Johnson (00:22:10):

Yeah, thank you Mat. I think that is excellent advice, isn’t it? Because I certainly know as a GP it’s not much help to me to send someone off to a psychologist to talk about their thinking if their physical health is deteriorating because the two, as Shannon rightly pointed out, they go hand in hand. They’re one and the same thing. So while people think whether they want to respond to Mat, I want to throw in another myth, which I do think is something that patients often say to me when we have conversations about how hard would it be to stop smoking, which is that people worry about their weight blowing out and they’re already overweight and stopping smoking will make them gain weight. I’d like some of you experts to help bust that myth because I think that is a myth that we hear from our patients all the time and it would be nice to have something useful to say to them to help us that who’d like to speak there.

Assoc Prof Mat Coleman (00:23:04):

I can add some weight to that, pardon the pun. There is some evidence, especially in the short term that part of the action of nicotine is that it’s an appetite suppressant. And so when you remove nicotine from a person’s system and if they go cold Turkey, you can have a rebound effect in appetite. But when you think about the various forms of treatment, particularly the evidence-based treatment that are in the R excellent R-A-C-G-P smoking cessation guidelines, particularly around nicotine replacement therapy, then if you are managing someone or helping someone to stop smoking tobacco and providing them with nicotine, you don’t actually get that effect. And so people don’t get that immediate acute effect of the increase in the appetite. It’s also to think about, and thanks to Shannon thinking about the person and their overall health rather than just a particular individual problem because when you also address and assist someone to stop smoking tobacco and you look at their overall holistic health from a respiratory and cardiovascular point of view, more capable and able to engage in physical activity and exercise, which can also balance any changes in other behaviours like compensatory oral emotional eating if that’s a problem.

(00:24:38):

But again, I think it’s taking and the evidence shows when you have a comprehensive treatment plan that looks at tobacco cessation for a person and consider their overall health and wellbeing, that weight generally can be managed quite well and that you don’t get this toing and froing, which really is what people’s experience is when they’re try and stop smoking on their own. I stopped, I had a few days off, I goed, I ate lots because I had this nicotine withdrawal and I put on weight and that’s what their lived experience is. But the important bit for me is it’s often their lived experience when they’re not getting comprehensive support with that comprehensive support, that’s what makes the difference

Assoc Prof Caroline Johnson (00:25:26):

Like to add something there.

Kate Cogan (00:25:27):

I agree, Mat, we look at trying to provide a bit of a care plan and look at the person holistically, so the physical health and their mental health and look at ways where they can increase their exercise a little bit and start to feel a bit more physically well as well.

Assoc Prof Caroline Johnson (00:25:45):

Very good advice. Yes. I think to say that you would do one unhealthy behaviour to stop getting another unhealthy behaviour isn’t as logical as trying to get that support to change. And I was just at a two day workshop on motivational interviewing just yesterday and the day before where we talked about some of the communication styles that would help with that. And I’m sure many people in this audience tonight have had training in motivational interviewing, but I don’t think that it’s routinely given to all mental health professionals. So if you are someone who hasn’t done that training, it might be worth looking into. I want to give you one more myth before we go into talking about the guidelines and I guess the one that I think is quite important is the kind of reasons people have that they’re not doing so much harm. And the two that I think came out on the myth that I often hear as a gp, it’s not like I’m harming anyone else and I only smoke heavily on the weekends. What people’s comments about those kind of myths? Sally, you raised an eyebrow. Do you want to say something?

Sally Plever (00:26:51):

No, but raise an eyebrow because unfortunately every cigarette is bad and it doesn’t Mater if it’s just a few or if it’s a lot they’re bad and particularly people with mental illness tend to smoke them differently in that they smoke them a lot deeper, a lot harder. So even if you are just doing a couple, they’re often smoking them in the worst possible way if you like. So just that couple is not ideal in any way and there’s a lot of talk around reducing to quit and that can be a really good strategy to get people on their way, but still knowing overall that smoking is just not good for you and any smoking at all is really not doing your health a lot of help.

Kate Cogan (00:27:42):

And if you’re smoking around other people, and Mat, you can probably know the figures better than me, but there’s quite a significant number of people that have health issues because they’ve been in the same room continuously for people with smoking or in the car with someone that’s been smoking and even I was reading recently where Ash left around and people picked that up. If that’s happening all the time, then they’re getting physical health problems because of that.

Assoc Prof Mat Coleman (00:28:12):

Yeah, everyone’s very familiar with secondhand smoke. That’s why we’ve got public health regulations of people only being able to smoke outside and not even close and we’re very comfortable with that. Most smokers and most people who are non-smokers are aware of that, but what people aren’t aware of is what’s referred to as thirdhand smoke and the actual smoke with its carcin engine settles onto furniture, it settles on things and touching it and picking it up and there’s transdermal absorption. So it not just a concept, but it’s a reality that a lot of people aren’t aware of. I just want to pick up on one point if I may, Carolyn, and that’s the issue around particularly for people who have a co-occurring mental health problem usually, and what Sally was saying is correct is usually we find that people with a mental illness mental health problem are more heavily dependent than your average smoker.

(00:29:12):

So they do tend to smoke more, deeper, harder or the topography of their smoking, they’re more likely to be more heavily addicted. And so the language that I try and teach junior doctors and other mental health professionals is that the smoking of the tobacco is the bad bit. Nicotine can be good and this is the conversation that people don’t have and I often say, look, I’m a real advocate for nicotine and that’s a very different conversation. You see smokers go, what? You are a bit of a weird doctor and we’ll say we’ve got a whole suite of nicotine, what would you like because you’re addicted to nicotine, it’s the smoke, it’s the tobacco that’s going to kill you. And all of a sudden we’re going from conversation which is about bad versus good shame versus whatever the opposite of shame is and consciousness to one, which is it’s the tobacco.

(00:30:13):

This is about your health, this is about what’s going to kill you. I understand that you might be addicted to nicotine and it does things for you and nicotine is okay, we’ve got nicotine replacement therapy and you might’ve tried it and you might’ve failed because we probably didn’t give you enough and didn’t tell you enough about and support you. That’s a very different conversation. So in services that I’m involved in, we’ve abandoned the Q word, the quit word, it’s not about quitting, we’re not going to help you to quit nicotine necessarily. We want you to continue on nicotine, so we have smokers clinics because you’re an expert at smoking, we just want to deal with the tobacco. So just changing the language and being more hopeful, supportive and thinking about what are we trying to help people with which is the nicotine dependence, getting rid of the tobacco smoking, which is the bit that’s going to kill you. It’s just a different conversation.

Shannon Harwood (00:31:08):

I’m nodding my head wildly Mat as you say that conversation because to me there are three parts of this. There’s the addiction, there’s the social setting, and this psychologically what I’m getting out of that as well. And when I’ve worked with people, I used to work as a peer worker and this also comes from gal mate I think is big on this concept. People don’t do things for no reason and the prevalence of nicotine use in this population, we probably won’t get to that today because we’re looking at minimization and how people can cease and how we can have those conversations. But there’s a fair bit of research out there about why people in this particular population might get a benefit out of nicotine and just to be able to take that pressure off and by focusing on the nicotine and saying, well, okay, well maybe I can deal with one thing at a time so maybe I can deal with my social cues for smoking first and then but not have to deal with the nicotine withdrawal at the same time.

(00:32:21):

It’s sort of breaking things down, isn’t it? Into bite size pieces and it’s offering choice about where it is not an all or nothing anymore. Suddenly it’s about, oh, where would I like to start thinking about as you say, this suite of things that I could do and I could nip in here or I could nip in there, but I’ve got a choice about where I jump in. I think that choice is so important rather than just an all or nothing. And I did just want to mention something, Caroline, about what you said about the person who comes to you in the GP clinic and says, I’m not hurting anybody else. When I heard that, I just was so immensely sad because I just want to grab that person and say, but the harm it’s doing to you, you are worth it. You are worth it. You are worth having health and this for you. And I found something terribly sad in that. Yeah,

Assoc Prof Caroline Johnson (00:33:17):

Yeah, I agree. And I think that’s very helpful line that people might be ready to deliver after hearing what you’ve shared. I just want to acknowledge there’s some good questions coming through that you’re actually almost answering without even knowing what the questions are team. So well done. Someone was made the point that sometimes in the short term, if someone’s depressed, they get an instant boost from smoking. And that’s really what you’ve just addressed there, Mat, that there’s a difference between the benefit you might get from the nicotine versus the danger of the tobacco. So I think you’ve kind of covered that hopefully for that listener, I’m going to now move to getting you to talk about the guidelines. We did ask people to read them and now I want to get you to reflect on them. Before we do that though, Shannon, I just want to frame this. We’re going to now go into guidelines which is going to tell you about things like nicotine replacement therapy and medications and all motivational interviewing, all that stuff. But Shannon, someone’s quite wisely asked in the chat. First, thank you for sharing your experience, but they’ve said they’ve worked with someone in the past, but every time he takes a step he falls back and they want to know what was your strongest motivation towards cessation.

Shannon Harwood (00:34:31):

I think in some ways this is a common journey in substance use disorders is you reach rock bottom. So I reached rock bottom and I ended up in that contemplation or purgatory space quite a bit. So bit finally, I mean there’s been various times along 30 years is a long time. There were a few different phases and times and ways and trials and things, but in the final days of it, I simply accepted that relapse is part of absolutely 100% part of success. Relapse is part of success. Relapse is part of the journey to success. I’m sure there’s some people out there who do it first go fantastic. But for me personally, what happened is that I would relapse, but I was never in the end after hitting rock bottom, I was never able to return to that place. It was harder and harder and harder to go back to denial. And so I ended up in this purgatory of sort of pre-contemplation, but I wasn’t able to be a happy smoker anymore. I became a very miserable smoker, more miserable than I had been, and I wasn’t able to just pretend and put it out of my mind. It just became, and so I had more and more frequently closer windows of giving up attempts, so I had more and more failures if you wanted to term it like that, I wouldn’t, I would say I had more and more attempts that led me to the final successful attempt.

Assoc Prof Caroline Johnson (00:36:09):

Thank you for sharing that. So important, and I think there’s two messages there for the audience. One is let’s have a conversation now about what we could do to help people be ready before they hit rock bottom. I guess it would’ve been nice to not hit the very rock bottom, but it isn’t important to recognise. But the other thing is I’d like people to also think about that fact that, and this is certainly what I was taught when I was in training, that most people who are successful in stopping smoking do have many goes. So just because you’ve tried and failed is not a reason to stop the average number. You’ve said it’s six, Mat, I was taught it was seven, but who cares? Six or seven. So even saying to people that that’s a magic average number, but everybody will be different. So it is really important to say it is always worth giving.

(00:36:53):

People hope to keep trying. With that, I will move to Mat now because I’m going a little bit behind time and this is where we are going to now. First of all, you have all had a look at the guidelines, I’m sure as part of your predisposing activity, and I should acknowledge that Mat’s had a role in helping develop these guidelines. So I’m sure he’s fond of them and will speak positively of them, but you are also welcome to critique them. I know when I’ve been on guideline guideline writing groups, you don’t agree with everything. So can we move now to you, Mat, and get you to talk a little bit about the guidelines?

Assoc Prof Mat Coleman (00:37:27):

Yeah, I won’t be long because they’re long and the development of clinical practise guidelines is a robust, lengthy process that I think I would just like the audience to be assured that they use the grade methodology, which is the international methodology. You can be reassured and assured that the guidelines are reviewed every few years they’re updated. Sometimes there’s additions like the vaping cessation addition to the guidelines, but that there’s a whole host of experts including people with lived experience, cancer council, gps, psychiatrists, addiction experts, public health experts that are involved in developing them. So what you read, you can trust. I guess the important bits from my perspective and from our perspective as mental health clinicians is a couple of things. Pardon me. One is we’ve gone from the process, pardon me, of asking and asking about smoking and then assessing people’s readiness for change.

(00:38:50):

The evidence now tells us really clearly that the more we engage in this ongoing process of assessing people’s readiness for change, we actually get worse outcomes. And that the assumption should be that any smoker knows and would prefer that if they could stop, they would stop. So stop assessing it. And I think the move away from Prochaska and DeClemente is pre-contemplation happy user to a process which goes from the five. A’s for the gps who are very familiar with the ask, assess, advise and arrange down to a three A’s for smoking cessation, which is ask if you do smoke, advise of what the next steps are. And really the most important thing is to act. And I would’ve preferred if it was one A, that’s my criticism. My one A would be as a mental health clinician or as a clinician, just act, let people opt out of treatment rather than asking do they need to opt in, stay involved and engaged in the attempt, as Shannon was talking about, and I always rephrase the narrative, if you’ve had a failed attempt, that’s excellent.

(00:40:06):

We’re one step closer to finally reaching the goal. Let’s have another go and it’s okay if we fail again. That’s actually one step even closer. So just changing that narrative, being positive and acting is one of the important points. And also moving away from the old school, how many cigarettes are you smoking a day? It’s particularly problematic. People with mental health problems, and as Sally was mentioning, you can be a 10 a day smoker and smoke like this or you can smoke 50 days. How many cigarettes a day is not terribly helpful. It’s time to first cigarette the moment you wake up in the morning. And indeed Shannon already alluded to it, and that’s the beauty of having people with real experience. You might even wake up through the night to have cigarette. This is the time to first cigarette is less than 30 minutes, potentially even less than 60 minutes. This person needs you to act with them to help. So to me, they’re the key messages out of this large document, the practise guidelines and the information that’s in there when you drill down is the latest and greatest information about the various treatments. And perhaps we can talk about that in a more sort of conversational way, but I’ll leave it there, Karen.

Assoc Prof Caroline Johnson (00:41:40):

Yeah, I mean I will interrupt now just because there is a bit of a hunger in the audience for questions that are coming through about medications. And to be honest, I’m much more interested in the conversation than the medication, but I do think we should acknowledge there is a need in the audience to talk about this. And I think fair enough, the two questions that have come through specifically about treatment are quite good ones. So I’m quite interested to ask. The first one is someone’s expressed the view that the most effective intervention is behavioural counselling plus a combination of two or three quit smoking medications. And in this participant’s view, the most effective meds which have to be prescribed by a GP are off-label, which is a combination of valine or bupropion plus nicotine patches. And they want to know how do we get psychologists to convince GPS to recommend that.

(00:42:29):

So I’d be very welcome for views perhaps here from Mat and from Sally and maybe from Kate one around, is that combination really that much better? Does it really Mater which combination we should be picking? And then secondly, if there is a combination that you think is better and you’re a psychologist and you can’t prescribe the medication, what should you be doing in your communication with the gp? So I dunno, Sally, do you want to talk first about just the communicating with the GP if you think they could be doing more and it does need a prescription?

Sally Plever (00:43:00):

That’s a really interesting question. I like that. The prescription is really interesting, certainly with a view for our mental health clinician. It’s actually really hard for us in public services to use the best medications, which is things like varenicline. We’ve got much more access to the short and fast acting NRTs, but we know Varenicline is actually very effective in this particular sort of cohort and it is so under prescribed, it’s not even funny. And there’s a lot of myths around it that have stuck and seem to be unable to be shifted from people’s view despite really good evidence to suggest that it’s actually a very safe and effective medication. And I’m glad to see you nodding your head, Mat, that I’m not leading people astray. And I think that providing some guidance to GPS about this is the particular person that you have and tailoring smoking cessation medications and NRT to the needs of that individual is so very important because one person might really like some of the NRTs and go, this really works well for me. Whereas someone else will say, this is terrible, it made me feel sick, or it burns my throat or I’ve put it on my skin. It doesn’t work. A lot of people are not using it correctly. Trying to talk to people about how they use it is really important. But in terms of convincing gps, I find most gps are very interested in hearing suggestions and a lot of consumers have an idea about what they want and what they don’t want. So listening to their needs are important. Mat, did you want to That’s a great

Assoc Prof Caroline Johnson (00:44:43):

Answer and I think yes, all the GPS out there, all the psychologists, you could always write to the GPS and say, I’ve been to this really cool webinar about these really cool guidelines. What’s your thought on, well, Mat, what is your thought on combining things as opposed to using one agent? Do you have a comment there?

Assoc Prof Mat Coleman (00:44:59):

Yeah, my first comment just to answer Sally’s response is it’s no coincidence that the guidelines are provided from the R-A-C-G-P. And so flicking your GP the web link and saying, ah, there is a role for you, can you have a look at these is important because there is a real problem in our medical in particular, but our health education system. And that’s why myth busting is so important. And actually it needs to be taken all the way back to, in my instance in medical school because smoking still sits in a social history rather than as a separate substance history. So we have fundamental problems in addressing smoking cessation. So we just want to make that clear. The evidence, I’ll switch it from the way that the audience member asked the question because the evidence really says that in someone who’s heavily dependent. So that’s that time to first cigarette less than 30 minutes, the leading agents will be pharmacological agents and reline is number one, NRT is number two, and that’s combination NRT, then bupropion, and then there’s others, the third line, fourth line agents, but the person was right, the addition of behavioural interventions and psychological supports increases the effect of those medications.

(00:46:27):

So it is the combination. There is evidence and there’s information in the clinical practise guidelines about combination of VARENICLINE and NRT, but you’re doing things one at a time. So you will have people that get a partial response to varenicline, but they’re still smoking two or three cigarettes a day and using pulsitile. So a nicotine spray under the tongue for those moments can be helpful for after a few weeks just to see if someone will have a full response. Then adding the NRT, not following the setting a quit date, but just seeing naturally how people respond. And obviously the combination whether you think NRT is just one homogenous group, actually combination NRT is by far the most effective combination in itself. And so I think about the patch, which acts it’s nicotine, but it acts slightly differently in reducing overall addiction plus the pulsatile bit, whether be chewing gum if you use it correctly, it’s not really chewing gum, it’s like putting in your chewing tobacco almost, but it’s the gum and you put it in your buccal fold or the spray and just using those for breakthrough craving. So that’s another combination. You do start to, we’re looking at combinations of bupropion and varenicline. You do start to get into tiger territory when as a prescriber, when you’re thinking about the cohort of people that we’re really focusing on people with co-occurring mental health problems because often on a lot of other psychotropics. So that’s where you’re starting to get into a cautious sort of area. But a combination of reline and NRT and combination NRT is definitely a good combination

Assoc Prof Caroline Johnson (00:48:19):

Right. Now I’ve got a question for Kate in just a sec, but before I move to you Kate, just one more question that’s come through, which is our GPS on board with prescribing sufficient nicotine replacement. So Mat, what’s your advice? I mean, would you say that if you go and follow the R-S-E-G-P guidelines, you’ll get to the maximum dose if you just follow what they say? Or do you think it’s too light touch?

Assoc Prof Mat Coleman (00:48:41):

No, the guidelines actually go, so unfortunately a lot of people just follow PBS and PBS is completely not. So the guidelines are very clear. There’s two problems with NRT. One is we underdose, and two is we don’t inform people of how to use it properly. So I’ve had a number of people on up to four patches a day. I know that that’s progressive. Getting to that point, I’ve had a colleague had one person on five and it worked. It’s, it’s very hard to overdose on nicotine through NRT. A person will feel sick, they’ll cut back naturally. But the real problem is underdosing. And the other problem is poor administration, people just putting the patch on in the same place, not rotating the patch in the same area or acknowledging that nicotine that’s delivered through the mouth. If you swallow, it’s deactivated, you’re no longer going to get it.

(00:49:44):

So I was talking about the chewing gum. It’s not chewing gum and swallowing the saliva, it’s actually chewing it, getting the signal of the mint flavour that’s telling the person that nicotine’s being delivered, shove it down in your buccal fold, keep it there. So it’s a chew and park technique, and once you start absorbing it correctly, then you’re not drinking lots of water or eating at the same time, then a person will start to absorb it. So administration and the guidelines talk about that, how to administer N RT and informing people of how to use it effectively will often deliver the amount of nicotine that they need for that replacement therapy.

Assoc Prof Caroline Johnson (00:50:23):

Fantastic. And that’s really good to know that the PBS might not be as good a guide as a guideline. So fantastic to hear that too. I want to switch to Kate now because there is a question here about clinical hypnotherapy. So I just wonder if you’ve got a view on the role of clinical hypnotherapy in smoking cessation?

Kate Cogan (00:50:42):

I have as a tool on its own, no, there’s no evidence to support it that it works. But in combination with pharmacotherapy, NRT behavioural change support, it is a useful aid to have in hypnotherapy, can weaken the impulses for the desire to smoke. It can strengthen the will to cease smoking and it may reduce levels of stress and can help eliminate habitual patterns. But by itself, there’s no evidence. And the Cochrane Cochrane reports support that and they provide a good systemic view that no, there’s no evidence that on its own it works. However, people do come in and ask for it. And in fact, I was at my GP last night and actually asked him what he thought.

Assoc Prof Mat Coleman (00:51:38):

It’s a difficult one, isn’t it, Kate? Because it’s a really common question. The way I as a clinician feed that back is I’ll say about evidence is I’ll say to people, sure, there are probably some people who have had success with it, but when we look at a hundred people and we give them hypnotherapy and a hundred people that don’t, there’s no difference between those.

(00:52:00):

And that starts to make sense because I think for a lot of people who are attending health services, when they hear there’s no evidence go, but Johnny down the road, he said it worked a treat, Frank. And you can say, yeah, it might’ve, but it might’ve. Something else might’ve worked as well. And talking about population evidence I think is really important and it gives it, because I see a lot of questions now around TMS, I’m throwing it in there, Carolyn, I saw advertisement for a practise that was offering TMS for smoking cessation. So transcranial magnetic stimulation for those that aren’t familiar with it, and there is no evidence for TMS in the same breath. I’m sure there are individuals who have improved, but when we do it in a research and methodical way, then we wouldn’t be recommending TMS. It’s very expensive. It’s time consuming. So giving people good advice is really important. And taking the research into the clinical space, I think, and how do you communicate that is equally important.

Sally Plever (00:53:13):

And that’s a good point, Mat, with the expense of it. It’s saying, okay, so you’ve got this, how much does that actually cost you? That’s quite a lot of money. Do you want to try something we know has actually got some effectiveness.

Assoc Prof Caroline Johnson (00:53:25):

So this is a good segue. We’ve talked a little bit about drugs and I could keep talking about them. I find it fascinating and there’s some good questions that have come through. But I think given that we have got the guidelines that people can refer to, and I’m getting the sense they’re probably pretty reliable guidelines for what most people will need. I want to move a bit more into sort some of the hurdles, enablers, which is what Sally was alluding to. Then do you talk about the cost of things? That’s a kind of a problem solving approach, isn’t it? Thinking about the pros and cons of different things and getting people to then work out for themselves come when they talk about it in motivational interviewing, give the person the good lines. If they’re saying themselves, gee, that’s costing a lot of money. They’re much more likely to believe their own voice than somebody lecturing them.

(00:54:08):

So this is what I want to move just for the next five minutes or so, I want to talk about your wisdom as a collective group around some of the key things. And Mat said, just act, act, act. I like that. But of course, we don’t really want people to badger patients. So what does acting look like that’s helpful and engaging? And Kate might have some thoughts around this and I’m sure Shannon will, but please just anyone chip in if they want to share something that they think makes a big difference when you’re starting to act. Shannon?

Shannon Harwood (00:54:41):

Yeah, I am interested in the conversation because when we just had a quick look through there at some of the things and some in those guidelines when we started to have that conversation, we can see how many different approaches there are and then hypnotherapy is thrown in. So going back to that idea of relapse, I see relapse as such a valuable opportunity in the way that you approach this to say, look, you will be able to stop smoking should you wish to. How do we do that? Okay, so that moment of relapse to me is an opportunity to just assess what did work and what didn’t work because there’s as much learning in what didn’t work as what did. And if there was just one approach, there would be just one approach. But there isn’t just one approach. There are many approaches and many people, and I agree with you, Sally, I’ve actually done hypnotherapy and I think it costs $600.

(00:55:45):

I mean maybe if you’re going to start somewhere, maybe you might like to look at your wallet in that as well. So where you start and what you learn as you go along. And when you get to the end of the process and you’re no longer smoking, and I always sort of take that fundamental belief that it’s just a Mater of how, not if, and it’s just finding out along the way and how long that takes and how you do that for each individual person. That’s a learning journey that you and that person are going to go along together. And the one thing I think we can do to support act is that very word support because there are differences in this population group. One of the, and I just want to touch just quickly on this. One of the things as someone with serious mental illness looking at this was insomnia is a trigger for illness for me, or it was right.

(00:56:37):

It used to be a really strong trigger for a bipolar illness. Now when I’m going into a cessation attempt, I really need to be able to work with someone about what I’m going to do if insomnia gets me. That is the moment of fear that is probably a little unique to this population as well. And we’ve just touched on probably don’t have time to do it, but we’ve just touched on other medications that people might be taking. So again, that support means support for adjusting medications if they’re needed, or looking at bridging medications to deal with sleep or looking for support at how we manage those factors along way.

Assoc Prof Caroline Johnson (00:57:19):

Very good advice. And I definitely agree that this isn’t a one size fits all problem. I find most things in life are not. And anyone who’s dogmatic that there’s only one way or the highway usually just gets the people who agree with them and not the rest of the population who need help. So being flexible, but also having those guidelines, I guess in the background to know where you can point people as to what’s most likely to work for most people is a very helpful conversation. Sally, what are your thoughts about some of the big either hurdles or enablers? I prefer to talk about enablers, I guess because hurdles just make us feel like it’s too hard. And you can always frame hurdle as an enabler if you flip it around, but what would you say to this conversation?

Sally Plever (00:58:01):

Well, largely having worked in public mental health services, one of the big things we say is keep asking the question. People actually want you to ask about their healthcare and smoking is part of that and don’t be afraid to be asking it. Most of the patients that I spoke to would often say, oh, you’re the first person who’s actually asked me about that. You think what? And one of the other things that I’ve spoken quite a lot with patients about these were inpatients is expectations around using NRT or other such things that it’s not going to be a magic fix that some people expect that once I put the patch on or have a puff of the inhalations that we have that it’s going to feel like smoking and it’s not. So that you’re not kind of setting people up to think that you’ve got a magic cure for them, that it’s still actually going to require a bit of effort.

(00:58:55):

But as we work as a team together, we can help you along the way. And certainly in the services that I’ve worked in, you often enter into a service that you’re not allowed to smoke. So all of a sudden you’ve got an opportunity here to try out some NRT. You’ve got an opportunity to see how you go and building self efficacy in people, because a lot of people I have found who have mental illness do not believe they can do this. And they failed a lot because we know it’s a chronic relapsing illness, but they’re seeing that as well. It’s just another thing that I can’t do and it’s too hard. So trying to work with that and every little people say to me, oh, giving up smoking’s easy. I’ve done that 20 times in the last week. It’s kind of continue with that. Every opportunity that you didn’t have complete success as a learning opportunity, what can we learn from that? Yeah, go ahead,

Assoc Prof Caroline Johnson (00:59:52):

Mat.

Assoc Prof Mat Coleman (00:59:53):

I think as a profession and at an individual person, patient level, we should take some responsibility in people’s experiences. I actually think it’s quite a productive way to approach it and say, and someone says, oh, but I’ve tried a patch before, and I usually say, we probably failed you. Actually, that was probably our fault because we didn’t give you enough. We didn’t show you how to use it, so I’m really sorry about that, that you had to go through. That was our fault. I was alerting to the fundamental problems that we’ve got in our education and training system. Most people don’t even understand nicotine. What it does, its metabolism, all these sorts of really basic things and how to use these agents correctly in terms of treatment yet will lump the failed attempt on the person who’s seeking help. When I can pretty confidently say most mental health and health clinicians actually, their knowledge about this is pretty poor.

(01:01:05):

So you can use that as a clinician to say, look, really sorry we failed you. I’ve asked you about what was your treatment been in the past and you’re given one patch that’s never going to work. I can’t believe we did that. I’m really sorry we did that. That must’ve been horrible for you. Can we have a crack at doing this properly? Again, that’s a very different conversation, and I’m not doing this as some sort of trick to engage someone that’s actually being honest as a profession. We are letting people down in the mental health field. We need to, I’ll say man up because it’s usually men. So I can be,

Assoc Prof Caroline Johnson (01:01:48):

Well, the reason the panel are made of women, I think we’d be happy to take that. But I do think, I mean there’s two big points there for the audience to take away. One is that, yes, it’s okay to show humility that sometimes we are not at the top of our game and we’ve misled people. And Sally’s point I think is very true about sometimes people don’t ask. In fact, lived experience, Australia did a survey of people who’d been in public hospitals and only 20% of them said that the mental health staff had asked any questions around the Equally Well areas that we’re trying to. So the idea that people I know should act Mat, but I guess to act you’ve got to at least have the conversation. So it’s all part of that. It’s being able to go into the conversation. There is an interesting question here, which I think might be a bit technical for me, but it is a general question someone’s interested in about nicotine’s effect on modulating neuroplasticity and the impact of nicotine on neuroplasticity may therefore play a role in the high probability of relapse in smokers. And so someone’s interested in your comments about this notion of nicotine and neuroplasticity. Who would like to comment on that?

Assoc Prof Mat Coleman (01:02:54):

I reckon I’m going to have to hear we’re not completely sure about some of the effects of nicotine and neuroplasticity. It was considered potentially a novel agent for the treatment of cognitive decline in dementia. Didn’t really hold up, but we know that it’s a cognitive enhancer. It’s one of the, let’s just think about what nicotine does. It is a calming agent, it’s an anxiolytic. It’s got a little bit of a euphoric effect. It’s a cognitive enhancer, it’s an appetite expression. Who doesn’t want that? And if you are struggling with a mental health problem where cognition, your affective state is affected, your ability to problem solve and be alert, then those immediate effects really make sense. And so there are some signals around, especially in people who have schizophrenia, that you get better outcome in terms of cognitive enhancement and the overcoming the cognitive effects of schizophrenia and the negative symptoms. But I wouldn’t be so bold to say it has neuroplastic effects. I think it’s a little bit more complex than that and it’s probably better just to think about the acute benefits of nicotine so that we we’re not just saying, oh, this is all bad. Actually. Of course there’s some benefits when you think about mental health conditions and symptoms and why it makes sense that you would want to utilise nicotine. And again, that starts to shift the conversation. So I’ve kind of skirted around the question. No,

Assoc Prof Caroline Johnson (01:04:46):

That’s fine. Mat. Thank you. I think that’s, hopefully the person who asked that question has got enough of your thoughts to know that it’s worth doing some more reading. I’m just going to move on. We’ve only got 10 minutes of this webinar remaining and I just want to ask one more question, which I think I’ll direct at Kate. We did want to, this is the mental health professionals network. So it is about all of us working together. And I know Kate and I have shared the care of people in our little metropolitan Melbourne. We talked to each other and I have to say the things I valued was when Kate would come to our clinic and actually write in the same notes that I was writing in. So I actually knew what had happened. So I’m a firm believer that we have to share, if you’ve given someone some good advice about nicotine, tell the other person who’s seeing this person, what you’ve said so they can reinforce it and not give the opposite advice, would be a really good start. But Kate, I’d just like if you could just give us a couple of reflections on what you think people in the webinar need to take away about how we can do this together as a group of professionals who are supporting people.

Kate Cogan (01:05:46):

I do think we need to create a team around somebody when we know that this is the goal. God, there’s so much you could say. I think we need to let people know that you will have a few attempts and each attempt you’ll get stronger at it and you’re getting closer to not doing. We need to educate people more. We as clinicians need to come up. We need to provide this team around people and communicate with each other so everyone knows where we’re up to.

Assoc Prof Caroline Johnson (01:06:16):

And Sally, do you have any reflections on what you think makes a team work better from your time in the system? Quite a lot of experience in the public system too.

Sally Plever (01:06:25):

Well, communication’s a good start, a consistent message, just the same thing over. And I cannot tell you how many times you speak to someone who has gotten a slightly different message on everything over and over again. Everybody asking the same question all the time so that people know that this is actually part of your healthcare and everybody asks it all the time. Smoking is so very important as you know, it’s the leading preventable problem that we could be doing something about, but it needs us all to be reiterating that over and over again to push the point. The other thing is that each of within our multidisciplinary team, we’ve all got certain specific skills that we can really drive. So thinking about how you might be able to do that across that bio-psychosocial components of smoking, because it’s certainly, as Shannon was saying, it’s all of those bits. You need to be addressing all of those things and all of our different multidisciplinary clinicians are able to do that in special ways, but the consistent message is just so important.

Assoc Prof Caroline Johnson (01:07:35):

Yeah, that’s very good advice. So I think on that note, I will now ask each panel member to reflect really something that they’ve learned from this discussion and then maybe one key message they’d like to hit home for the people who are listening. Maybe I’ll start. Can I start with Shannon, if that’s all right?

Shannon Harwood (01:07:54):

I’m smiling because I don’t know if anybody in the audience was ever an absolutely fabulous fan of that comedy ad fab where Patsy, the chronic smoker, put on 15 nicotine patches and were still smoking a pack a day. But listening to you speak about using those patches and using that in a different way. Some of that is new to me. So if I was sitting here at the point of a prescriber, I think I’d be going back and having a really close look at that again. Because I think the narrative that’s out there for smokers is I’ll go to the supermarket, I’ll buy a patch. Oh, the patch didn’t work. But that idea that you were talking about there in multiple patches to that point, and then other things on top of that, I think that is something that is not widely known at all in the smoking community for people who have mental illness.

Assoc Prof Caroline Johnson (01:08:56):

I agree. That’s been helpful for me too. Okay. So Mat, one thing you’ve learned and then one key message too, just keep it brief, we’ve only got a few more minutes.

Assoc Prof Mat Coleman (01:09:06):

It’s really just the extraordinary data that Shannon presented, unequally unwell, and it’s reconfirmed and recommitted me to and reinvigorated me in going beyond my scope, so to speak as a psychiatrist and really doubled down on people’s physical healthcare. So thank you, Shannon, thanks to Equally Well for the great work that was done on that report.

Kate Cogan (01:09:41):

Thank

Assoc Prof Caroline Johnson (01:09:41):

You. And Kate.

Kate Cogan (01:09:43):

Well actually I liked Mat’s comments about cutting out all the other a’s and just go with the act maybe be a bit stronger and a bit firmer right at the beginning. And I have the experience that people generally love information and sending them away with some information that they can process later on.

Assoc Prof Caroline Johnson (01:10:05):

That’s good. And I hope that’s what listeners have taken away as well. And Sally,

Sally Plever (01:10:09):

I like the stop assessing readiness because for many people it can be a really good excuse not then to do any of the act. So I like that a lot. And I think in terms of a message, my message would be that as a healthcare clinician, you have an opportunity to make a big difference here. So do it.

Assoc Prof Caroline Johnson (01:10:35):

Very good advice.

Kate Cogan (01:10:37):

And Caroline, can you tell us something that you’re going to take away from the panel’s discussion?

Assoc Prof Caroline Johnson (01:10:41):

Well, apart from learning how to pronounce RIS senline properly, I’ve been pronouncing it wrongly for 20 years. Even though I prescribe it, I better fix that. My big one, to be honest, was the, I’m a bit of a girly swat. I tend to follow the rules. And so if the PBS says this is what you can do, I go, well, it must be right, but clearly it’s not right. So Mat, thank you for giving me permission to break a few rules there that’ll really make my day because like most gps, I like to occasionally be a bit of a maverick. So thank you everyone. I mean, this has been a lovely session for me because it rounds off, as I say, I was in a motivational interviewing workshop for two days with some care navigators who were training to work with us in my PHN to help people with more severe mental health systems to do exactly this, to have the conversations that sometimes the gps don’t always have the time to do.

(01:11:35):

And we’re working with nurses in the practise who will be able to have conversations specifically around behaviour change, around things that affect people’s wellbeing. So this is a really exciting moment for me in my career trajectory to hear that there are lots of things happening and lots of resources we can use. To that end, I think there are a lot of resources that you can take home. And as well as the pre-reading, there are some really good resources particularly shared through the Equally Well around conversations that consumer can have with their clinician. And I think they’re good to look at because even if you’re a clinician, because you can maybe say to people you’ve got permission to ask, but here are some things you could take to your GP to help get the conversation started. So I think we have covered, I hope we’ve covered that you do have a bit of an idea of the prevalence and risks associated with it.

(01:12:23):

We gave you all the do doom and gloom statistics at the start, but then we moved pretty quickly into opportunities for open conversations and some strategies. And that was around both the technical sort of pharmacological things, but also just more broadly the resources. And I hope we’ve given a little taste of busting some myths around the hurdles and giving you some enablers. And I really, knowing that this audience is multidisciplinary, I’m hoping there are some of you who came to this thinking, well, I don’t really know if it’s my business to raise that when I’m doing therapy with someone. I hope you’ve taken away from this that absolutely it is everybody’s business to talk about smoking cessation. I think one thing I love talking about with young people is they don’t really like the idea that big tobacco companies are making a lot of money out of them.

(01:13:07):

And I think that’s the biggest, strongest argument for them to stop vaping as well. Why would you want to give money to a big evil company when it’s actually causing you harm and causing you to be addicted? And I certainly think that’s helped a lot of young people not even start. So this is a real call to arms and it really is one of the many bits of, it’s part of the work of Equally Well Australia, but it’s also part of the work of MHPN, which is to bring health professionals together to talk about things where we’re going to get the biggest bang for our collective buck. We’d like you to give feedback in the survey whether we met those expectations and if it was helpful for you. And please remember, if you want to claim CPD, you can access the learning outcome. So you can then put that up on your own CPD platform and you will be sent a certificate of attendance within three days to support any CPD claim if you need that. So on that note, I’m very proud to be finishing right on time. I’d like to thank all the panel members and I’d like to thank everyone for joining in on this activity. I think it’s been very powerful. I really enjoyed listening to you all, and I certainly feel inspired to go back into the clinical world and try and do a little bit more. Good. Thank you everyone. And goodnight.